Asian J. Nursing Edu. and Research 4(1): Jan.

-March 2014

www.anvpublication.org

ISSN-2231-1149

RESEARCH ARTICLE

Comparison of Infra Red Light Therapy vs. Sitz Bath on episiotomy in

terms of wound healing among postnatal mothers
Ms. Poonam Sheoran1, Ms. Sulakshana Chand2, Ms. Sukhwinder Kaur3
1

M.M Institute of Nursing, M.M University Mullana, Ambala Haryana.133207

Staff Nurse, Govt. Medical College and Hospital, Sec. 32, Chandigarh
Corresponding Author Email: poonamsheoran@rediffmail.com

ABSTRACT:
Episiotomy has been routinely used surgical procedure to facilitate delivery. Maternal benefits attributed to the use of
episiotomy include a reduced risk of perineal trauma, subsequent pelvic floor dysfunction, prolapse, urinary
incontinence, faecal incontinence, and sexual dysfunction. Potential benefits to the foetus were thought to include a
shortened second stage of labour resulting from more rapid vaginal delivery. The present study is aimed to compare
the effectiveness of infra red light therapy vs. sitz bath on episiotomy in terms of episiotomy wound healing among
postnatal mothers. The study was conducted in postnatal wards of Government multi speciality hospital, Chandigarh.
A sample of 60 postnatal mothers with episiotomy was selected using purposive sampling; of these 60 postnatal
mothers, 30 were treated with infra red light and remaining thirty postnatal mothers were treated with sitz bath. Data
was collected using REEDA Scale. Analysis of data revealed that both sitz bath and infra red light therapy were
effective in enhancing episiotomy wound healing, however, sitz bath was significantly more effective in promoting
episiotomy wound healing as compared to infra red light. No significant association was found between episiotomy
wound healing of the postnatal mothers treated with infra red light therapy and sitz bath and selected variables.

KEY WORDS: Episiotomy, postnatal mothers, infra red light therapy, sitz bath, wound healing
INTRODUCTION:
Perineal trauma can cause considerable distress and
discomfort to many women following childbirth. Perineal
trauma affects the mental, social and physical wellbeing of
the woman. Some have postpartum pain and discomfort,
which may persist beyond the puerperium as chronic pain
and dyspareunia. In addition, infection, wound breakdown,
urinary and faecal incontinence and other spectrum of
adverse effect of treatment of perineal trauma can make the
postpartum period very unpleasant. While factors like
suture techniques, operator skills and suture materials may
affect perineal pain and wound healing, different strategies
have been used in order to promote episiotomy healing.
Severity of perineal discomfort was frequently under
estimated and many women suffered without cause, very
frequently in silence.

Received on 26.08.2013
Accepted on 05.02.2014

Episiotomy refers to a surgical incision into the perineal

body to enlarge the vaginal opening to facilitate birth or to
prevent perineal tears. Episiotomy is one of the most
common procedures performed during delivery, yet, there is
extensive disagreement about necessity and benefits of this
procedure1. It is also defined as the surgical enlargement of
the vaginal orifice by an incision of the perineum during the
last part of the second stage of labor2.
Even though episiotomies have been performed for several
hundred years, the routine practice of episiotomy was not
adopted until the 1920s. For decades, episiotomies have
been performed on a routine basis to help speed delivery
during the second stage of labor; as well as to prevent tears
to the mother's vagina, especially serious tears that may
stretch to the urethra or the anus. The procedure was also
thought to lessen trauma to the baby and protect the
mother's vaginal muscles.

Modified on 25.12.2013
A&V Publication all right reserved

Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 70-75

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Asian J. Nursing Edu. and Research 4(1): Jan.-March 2014

Used widely in the present day, episiotomy is advocated to

have several advantages such as prevention of lacerations,
better healing, easier to repair than a ragged tear, allows for
easier and safer regression of the head thereby preventing
possible brain damage reduced incidence of uterine
prolapse in subsequent deliveries. If performed before,
tissues are overstretched, shortens the second stage of labor
and it may prevent painful hemorrhoids. It is also
performed for a majority of forceps deliveries, breech and
face deliveries.

experimental group each. Data was collected using REEDA

scale to measure wound healing. The results of the study
indicated that the infra red therapy enhanced wound healing
in postnatal mothers9.

A study was conducted to evaluate the effectiveness of

warm versus cold sitz bath to relieve edema and hematoma,
as well as to reduce the sensation and distress of pain in 20
postpartum mothers. Findings revealed that, although cold
bath was significantly more effective in reducing edema,
both cold and warm sitz bath were found comparable in
The rate of episiotomy rates vary widely worldwide relieving hematoma formation10.
depending on its restrictive or routine use. Studies reveal
that episiotomy rates vary from 8% in the Netherlands, 13% Postnatal infections are the leading cause of hospital
in England to 25% in the USA. In developing countries, acquired infection and a leading cause of maternal
episiotomy rates are still high as restrictive use of morbidity and mortality. They expose mothers to increased
episiotomy has not been widely embraced in risk of delayed mother-infant bonding, prolonged hospital
primigravidas3. Episiotomies in the United States have stay or re-admittance to the hospital, lactation difficulties,
declined since the late 1970s from 61% in 1979 to 25% in increased expense and possibly permanent injury or death10.
20044.
Today, when the cost of medical treatment and care is
soaring. Providing economical care to patients with
A study determined episiotomy rate in 1345 vaginal births episiotomy is possible provided nurses realize the relevance
in Nigeria. Findings revealed that the prevalence rate of of their care and potential impact of the advocated
episiotomy was 46.6% and over 90% of the primigravida procedure in wound healing as nurses play an important
had undergone episiotomy.
role in the care of perineal wounds following childbirth.
A study conducted by Sathiyasekaran BWC et al6
investigated the episiotomy rate in Chennais rural
population on a sample of 442 postnatal mothers who had
delivered vaginally. Findings revealed an overall
episiotomy rate of 67% among these mothers. It was
concluded that episiotomy rates were high and even higher
when delivery was conducted by a doctor and place of
delivery was private medical college hospital.

Available data demonstrates that high percentages of

women are undergoing episiotomy during child birth.
However, at the same time episiotomy wound is a neglected
aspect in post natal case both by the health personnel and
mothers themselves. This in part may be attributed to work
load or lack of understanding of importance good
episiotomy wound healing in the long term. Mothers lack
of knowledge or health status may also be considered as a
contributing factor. Infection of episiotomy wound can lead
In this era of advanced modern technology all mothers are the puerperal sepsis. Puerperal sepsis is one of the major
looking hopefully at nurses to help in bringing down the causes of maternal morbidity and mortality.
maternal morbidity rate and relieve them from suffering,
pain and discomfort after child birth. Thus, it becomes the From investigators personal clinical experience, it has been
nurses responsibility to identify the ways of preventing and observed that most of the mothers with episiotomy
reducing maternal morbidity as well as to identifying the remained in the bed in lying position as they had difficulty
cost effective measures in relieving pain7.
while sitting properly and breastfeeding. Keeping in mind
the current trends in health care, postnatal mothers may be
Postnatal mother might have painful micturation because of discharged from the hospital on 2nd or 3rd postnatal days
local bruises on the vulva, clitoris, vagina and the with incomplete wound healing and persisting pain.
episiotomy scar. Retention of urine may occur due to So, the investigator felt the need to evaluate the
painful scar or the operative delivery. Sitz bath provide pain effectiveness of Infrared radiation therapy vs Warm sitz
relief, infrared exposure relives perineal pain. Analgesics bath on level of pain in episiotomy wound among postnatal
may require for treating local pain7.
mothers.
Exposure the perineum to dry heat in the form of a perineal OBJECTIVES:
hot pack or moist heat by a sitz bath are ways of increasing 1. To compare the effectiveness of infra red light therapy
circulation to the perineum and therapy to reduce pain,
vs. sitz bath on episiotomy in terms of wound healing
edema, promote healing and provide comfort8. An
among postnatal mothers.
experimental study was undertaken to investigate the effect 2. To determine the association of wound healing scores
of infra red therapy on episiotomy pain and wound healing
of post natal mother with selected variables.
in 60 postnatal mothers with episiotomy at selected
hospitals at Kovilpatii by randomly assigning 30 postnatal
mothers to control group and 30 postnatal mothers to

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Asian J. Nursing Edu. and Research 4(1): Jan.-March 2014

46.7% in group 2 (sitz bath therapy) had primary level of

MATERIAL AND METHODS:
education. Majority of the postnatal mothers (73.3%) in
Approach and design:
The research approach adopted for the study was group 1 (infra red light therapy) and 83.3% in group 2 (sitz
bath therapy) belonged to nuclear family. Majority of the
experimental approach with repeated measures design.
postnatal mothers (70%) in group 1 and group II were
primipara. All samples(100%) in Group I and group II were
Setting and Subjects:
The present study was conducted in the postnatal ward of with singleton pregnancy. All (100%) the postnatal mothers
Government Multi specialty Hospital, Chandigarh. This 500 had spontaneous delivery in group 1(infra red light therapy)
bedded hospital has 24 hours round the clock emergency and 3.3% in group 2 (sitz bath) had aided delivery. Majority
and indoor facilities manned by specialists. Major of the postnatal mothers (83.3%) in the group 1 (infra red
specialties provided in this hospital were Medicine, light therapy) received cephalosporins as antibiotics as
Surgery, Orthopedics, Gynecology and Pediatrics. Casualty compared to 6.7% in group 2 (sitz bath therapy). whereas
and Emergency Services are provided 24 hours all days. A 93.3% postnatal mothers in group 2 (sitz bath therapy)
sample of 60 postnatal mothers was selected using received amino-glycosides as compared to 16.7% in group
purposive sampling technique. Thirty postnatal mothers 1 (infra red light therapy).
were allotted for the treatment of infra red light therapy and
another thirty postnatal mothers were allotted for treatment Table 1: Comparison of infra red light therapy and sitz bath
therapy in terms of wound healing scores among the postnatal
with sitz bath. The study was carried out in the month of mothers on day 3.
N=60
December 2010-January 2011.
Therapy
Mean
MD
SDD
SEMD
t value
Tool:
The tools used for the study were socio demographic tool
and REEDA scale. Socio Demographic tool consisted of 11
items seeking information on background data such as age,
education, type of family, parity, type of delivery, type of
pregnancy, type of antibiotic therapy. REEDA Scale was
used to assess healing of the perineum. It comprised of five
items related to redness, edema, ecchymosis, discharge and
approximation. The maximum score for REEDA was 15
and the minimum score was zero.

1.43
0.30
0.15
0.11
Infra red
light (n=30)
1.13
Sitz bath
(n=30)
t(58) = 2.00, p0.05 ; *significant at 0.05 level

2.72*

The data presented in table 1 shows that the mean wound

healing score (1.43) of postnatal mothers receiving infra red
light therapy was higher than the mean wound healing score
(1.13) of postnatal mothers receiving sitz bath therapy with
a mean difference of 0.30. This obtained difference was
found to be statistically significant as evident from the t
value of 2.72 for df 58 at 0.05 level of significance. Hence
Reliability:
it can be inferred that sitz bath was more effective in
Reliability of the REEDA Scale was established by Kappa
promoting wound healing after episiotomy among postnatal
method of inter rater reliability and was found to be .75
mothers.
(acceptable range .61-.81 COHEN)
Procedure:
Administrative approval and ethical clearance was obtained
from the designated authority and institutional ethical
committee respectively. Written consent was obtained from
the participants after explaining the nature and purpose of
the study. Confidentiality and anonymity was ensured. First
thirty postnatal mothers allocated to group I received infra
red light to the episiotomy for 15 minutes. Next 30
postnatal mothers allocated to group 2 received sitz bath to
the episiotomy for 15-20 minutes. Each therapy was
provided twice daily for three consecutive days. Healing of
wound was observed after giving the treatment using
REEDA Scale. The obtained data was analyzed by using
descriptive and inferential statistics.

Table 2: Observation wise mean, mean difference, standard

deviation difference, standard errors of mean difference of wound
healing scores of postnatal mothers receiving infra red light
therapy from day 1 to day 3
N=30
Observations
Mean
MD
SDD
SEMD
t value
1.67
0.04
0.01
0.13
0.25NS
Observation 1
1.63
Observation 2
1.63
0.20
0.01
0.11
1.80NS
Observation 2
1.43
Observation 3
1.67
.24
0.02
0.09
2.53*
Observation 1
1.43
Observation 3

Data presented in table 2 shows that the mean wound

healing score of postnatal mothers receiving infra red
therapy was 1.67 and 1.63 on day one and day two
respectively with a mean difference of 0.04. This difference
was not found to be statistically significant at 0.05 level of
RESULTS
significance as indicated by the computed t value of 0.25 df
Findings related to demographic characteristics of
(29).
postnatal mothers
Nearly three fourth of postnatal mothers (76.7 %) in the
The mean wound healing score of postnatal mothers
group 1 and two third of mother (66.7%) in group 2 were in
receiving infra red therapy was 1.63 and 1.43 on day two
the age group of 18-25 years. Nearly half of the postnatal
and day three respectively with a mean difference of 0.20.
mothers (53.5%) in group 1 (infra red light therapy) and
This difference was not found to be statistically significant

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Asian J. Nursing Edu. and Research 4(1): Jan.-March 2014

at 0.05 level of significance as indicated by the computed t The mean would healing score of postnatal mothers
value of 1.80 df (29).
receiving intra red light and sitz bath was 1.63 and 1.63
respectively on day two with a mean difference of 0.00.
The mean wound healing score of postnatal mothers This difference was not found to be statistically significant
receiving infra red therapy was 1.67 and 1.43 on day one at 0.05 level of significance as indicated by the computed t
and day three respectively with a mean difference of 0.24. value of 0.00 df (29).
This difference was found to be statistically significant at
0.05 level of significance as indicated by the computed t The mean would healing score of postnatal mothers
receiving intra red light and sitz bath was 1.43 and 1.13
value of 2.53 df (29).
respectively on day two with a mean difference of 0.30.
Thus it can be inferred that infra red light therapy was This difference was found to be statistically significant at
effective in promoting wound healing after being 0.05 level of significance as indicated by the computed t
administered for three consecutive days.
value of 2.69 df (29).
Table 3: Observation wise mean, mean difference, standard
deviation difference, standard errors of mean difference of wound
healing scores of postnatal mothers receiving sitz bath therapy
from day 1 to day 3
N=30
Observations Mean Mean
SDD SEMD
t value
Difference
Observation 1
Observation 2
Observation 2
Observation 3
Observation 1
Observation 3

1.77
1.63
1.63
1.13
1.77
1.13

0.14

0.13

0.14

0.94NS

0.50

0.21

0.14

3.52*

0.64

0.08

0.08

7.08*

Thus it can be inferred that infra red light theray and sitz
bath therapy are comparable in promoting wound healing
after episiotomy, while sitz bath is more effective.
Findings further revealed there was no significant
association of wound healing scores of the postnatal
mothers receiving infra red light therapy and sitz bath
therapy with the selected sample characteristics viz age,
level of education, type of family, parity, mode of delivery,
and type of antibiotics prescribed.

DISCUSSION:

Data presented in table 3 shows that the mean wound

healing score of postnatal mothers receiving sitz bath
therapy was 1.77 and 1.63 on day one and day two
respectively with a mean difference of 0.14. This difference
was not found to be statistically significant at 0.05 level of
significance as indicated by the computed t value of 0.94 df
(29).
The mean wound healing score of postnatal mothers
receiving sitz bath therapy was 1.63 and 1.13 on day two
and day three respectively with a mean difference of 0.50.
This difference was found to be statistically significant at
0.05 level of significance as indicated by the computed t
value of 3.52 df (29). Thus it can be inferred that sitz bath
therapy was effective in promoting wound healing after
being administered for three consecutive days.
The mean wound healing score of postnatal mothers
receiving sitz bath therapy was 1.67 and 1.43 on day one
and day three respectively with a mean difference of 0.24.
This difference was found to be statistically significant at
0.05 level of significance as indicated by the computed t
value of 2.53 df (29). This, it can be inferred that sitz bath
therapy were effective in promoting episiotomy wound
healing after from 2nd observation onwards.
Data presented in table 4 shows that the mean would
healing score of postnatal mothers receiving intra red light
and sitz bath was 1.67 and 1.77 respectively on day one
with a mean difference of 0.10. This difference was not
found to be statistically significant at 0.05 level of
significance as indicated by the computed t value of 0.85 df
(29).

The number of women who die during pregnancy or

childbirth has reduced by nearly 50% globally since 1990
from 543,000 to 287,000. In the developing regions, the
number of maternal deaths per 100,000 live births, the
maternal mortality rate has fallen from 440 in 1990 to 240
in 2010. Eastern Asia has the lowest level in the developing
regions with the maternal mortality rate of 37. But for every
woman who dies, approximately 20 others suffer injuries,
infection, and disabilities11. The present study was aimed at
comparing the effect of infra red ray therapy versus sitz
bath therapy in terms of episiotomy wound healing of
postnatal mothers. Findings of the present study revealed
that infra red light therapy and sitz bath therapy were
effective in promoting episiotomy wound healing. These
findings are consistent with the findings reported by
Baruahb B et al which reported that infra red light was an
effective therapy for episiotomy wound healing12.
Venkadalakshmi1 V et al 9 also reported that infra red
therapy was effective in enhancing episiotomy wound
healing among postnatal mothers.
Finding further showed that sitz bath therapy was effective
in promoting episiotomy wound healing among postnatal
mothers. These findings are consistent with the findings
reported by Michel S, which revealed that sitz bath was
effective in promoting episiotomy wound healing among
postnatal mothers
No significant association was found between episiotomy
wound healing and age, education, type of family, parity.
These findings are consistent with the findings reported by.
Begum S13 also reported no significant association of
episiotomy wound healing of postnatal mothers and
selected variables age, education, occupation, parity and
activity13.

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Asian J. Nursing Edu. and Research 4(1): Jan.-March 2014

Table 4: Observation wise mean, mean difference, standard deviation difference, standard errors of mean difference of wound healing
on day 1 to day 3 of infrared light therapy and sitz bath.
N=60
Therapy
Observations
Mean
Mean Difference
SDD
SEMD
t value
Infra red light
Observation 1
1.67
0.10
0.05
0.11
0.85NS
Sitz bath
Observation 1
1.77
Infra red light
Observation 2
1.63
0.00
0.01
0.14
0.00 NS
Sitz bath
Observation 2
1.63
Infra red light
Observation 3
1.43
0.30
0.15
0.11
2.69*
Sitz bath
Observation 3
1.13

Although application of both infrared and sitz bath therapy

Demonstration to the students and regarding use of
was effective in enhancing the healing process, however
infrared rays and sitz bath therapy should be done.
findings revealed that REEDA score was significantly
lower among post natal mothers who received sitz bath NURSING ADMINISTRATION:
therapy. These findings are consistent with the findings
Dissemination of research information through
reported by Dutta A14 which revealed that sitz bath was
multiple channels such as publications, conference
effective in episiotomy healing. This could also be
paper presentation related to strategies to improve
attributed to the fact that both wet and dry heats have local
perineal healing of postnatal mothers.
effects on wound healing. Moist application warms the skin
Journal club presentations related to most current
more quickly and is more penetrating than application of
evidence based practices for management of
15
dry heat as water is a better conductor than air .
episiotomy and latest innovations.
Provide perineal care guidelines and protocols for
Findings further revealed that there was no significant
nurses providing postpartum care.
difference between the wound healing scores of mothers
Availability of episiotomy kits for mothers who have
receiving infra red light and sitz bath therapy. However, on
episiotomy wound at the time of admission in the
day two and three, the REEDA scores of postnatal mothers
postnatal ward.
receiving sitz bath were significantly lower than mothers
receiving infra red light. These findings are parallel to the
findings reported by Kaur N et al which showed that RECOMMENDATION:
A study on larger sample for generalization of results
episiotomy healing of mothers who received sitz bath
A study to determine effectiveness in terms of cost and
therapy was comparatively quicker as compared to mothers
nursing time of different strategies used for providing
who received dry heat therapy with a hair dryer16.
episiotomy care.

IMPLICATION:
Perineal trauma due to episiotomy causes a number of
distressing conditions in postnatal period such as
discomfort, pain and disturbed normal activities increased
the risk of infection. In addition, these mothers experience a
feeling of inadequacy, prolonged postnatal recovery and
increased cost of healthcare. The findings of the study
imply that there is need for ensuring comfort and promoting
episiotomy wound healing of postnatal mothers.

LIMITATION:
Limited sample size, hence generalization is not possible

REFERENCES:
1.

2.

NURSING PRACTICE:

Although all pregnant mothers may not end up having 3.

episiotomy at the time of delivery, however, educating 4.
mothers regarding use and advantages of sitz bath in
the postnatal period can promote perineum
recuperation.
Nurses working in postnatal wards can consistently 5.
practice the use of infrared light and sitz bath to
provide comfort to the postnatal mothers and hence
promote healing.
6.

NURSING EDUCATION:
Nurse educators should orient the students towards
various forms of interventions for episiotomy pain and
wound healing.

74

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